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Chandler R, Farinu OTO, Guillaume D, Francis S, Parker AG, Shah K, Hernandez ND. Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study. JMIR Res Protoc 2023; 12:e42712. [PMID: 37713259 PMCID: PMC10541635 DOI: 10.2196/42712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. OBJECTIVE The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. METHODS Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. RESULTS Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. CONCLUSIONS The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42712.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Oluyemi T O Farinu
- Department of Sociology, Georgia State University, Atlanta, GA, United States
| | - Dominique Guillaume
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sherilyn Francis
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrea G Parker
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kewal Shah
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Natalie D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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Chandler R, Guillaume D, Wells J, Hernandez N. Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031414. [PMID: 35162438 PMCID: PMC8835000 DOI: 10.3390/ijerph19031414] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women's perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app-Savvy HER-which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women's PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
- School of Nursing, Johns Hopkins University, Baltimore, MD 21224, USA
- Correspondence:
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Natalie Hernandez
- Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
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Miner MD, Bekker LG, Kredo T, Bhagwandin N, Corey L, Gray GE. Meeting report: South African Medical Research Council Standard of Care in Clinical Research in Low- And Middle-Income Settings Summit, November 2017. Trials 2021; 22:778. [PMID: 34742340 PMCID: PMC8572437 DOI: 10.1186/s13063-021-05754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure prophylaxis (PrEP) was recommended by the World Health Organization for persons at high risk of acquiring HIV, but not all countries immediately adopted those recommendations. The South African Medical Research Council (SAMRC) convened a summit to discuss issues relating to SoC and PrEP in HIV prevention clinical trials taking place in lower- to middle-income countries (LMIC). Policymakers, regulators, ethicists, experts in law, researchers, representatives of advocacy groups, and the HIV Vaccine Trials Network (HVTN) presented a framework within which SoC principles could be articulated. A group of subject matter experts presented on the regulatory, ethical, scientific, and historic framework of SoC in clinical trials, focusing on PrEP in South Africa. Summit participants discussed how and when to include new HIV treatment and prevention practices into existing clinical guidelines and trial protocols, as well as the opportunities for and challenges to scaling up interventions. The summit addressed challenges to PrEP provision, such as inconsistent efficacy amongst different populations and various biological, virological, and immunological explanations for this heterogeneity. Advocates and community members propagated the urgent need for accessible interventions that could avert HIV infection. The meeting recommended supporting access to PrEP in HIV prevention trials by (1) developing PrEP access plans for HIV vaccine trials, (2) creating a PrEP fund that would supply PrEP to sites conducting HIV prevention trials via a central procurement mechanism, and (3) supporting the safety monitoring of PrEP. This report summarizes the presentations and discussions from the summit in order to highlight the importance of SoC in HIV prevention clinical trials.
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Affiliation(s)
- Maurine D Miner
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, P.O. Box 13801, Mowbray, Cape Town, 7705, South Africa
| | - Tamara Kredo
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | - Niresh Bhagwandin
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa
| | - Lawrence Corey
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA
- Department of Medicine and Laboratory Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Glenda E Gray
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA.
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa.
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Busza J, Phillips AN, Mushati P, Chiyaka T, Magutshwa S, Musemburi S, Cowan FM. Understanding early uptake of PrEP by female sex workers in Zimbabwe. AIDS Care 2020; 33:729-735. [PMID: 33043688 DOI: 10.1080/09540121.2020.1832192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Female sex workers (FSW) are prioritised for increased access to pre-exposure prophylaxis (PrEP), although rates of uptake remain sub-optimal, particularly across Southern Africa. In the first two years of its availability in Zimbabwe, 37.1% of FSW in trial sites initiated PrEP and received at least one re-supply. We conducted a qualitative study on perceptions of PrEP among 19 early users selected from sites with varying rates of PrEP initiation. Narrative interviews examined the pathways taken by FSW from hearing about PrEP, through their decision to start taking it, and early experiences. FSW appreciated PrEP's introduction within familiar and trusted "friendly" services tailored for sex workers and valued positive encouragement from clinic staff and peers over negative influence from family members. They also found PrEP difficult to understand at first, and feared side effects and rare adverse complications described in information leaflets. While FSW identified individual strategies for remembering to take their medication, they also relied on structured peer adherence support, leading some FSW to actively promote the method to other FSW as "PrEP champions". Information on how early users experience a new prevention technology such as PrEP can inform design of interventions that leverage existing support structures and target key barriers.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | | | | | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe.,Liverpool School of Tropical Medicine, Liverpool, UK
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Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, Hernandez N. The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women. BMC Public Health 2020; 20:1172. [PMID: 32723313 PMCID: PMC7385954 DOI: 10.1186/s12889-020-09248-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background Consistent use of Pre-Exposure Prophylaxis (PrEP), a biomedical intervention for HIV seronegative persons, has been shown to significantly decrease HIV acquisition. Black women are a viable population segment to consider for PrEP use as their HIV incidence is overwhelmingly higher than all other women groups. Methods We developed and piloted a cultural- and age- appropriate PrEP education intervention to determine Black college women’s: 1) perceptions of and receptivity to PrEP use; and 2) preferences for PrEP information delivery. Results We recruited N = 43 Black college women. Most of our sample were sophomore and Juniors of whom identified as heterosexual (83%) and single (67%). Over 50% of young women had never been HIV tested and only 28% had been tested in the last 6 months; however, 100% of the women believed their HIV status was negative. Prior to participating in the study, most Black college women (67%) had not heard about PrEP and were unsure or apprehensive (72%) to initiate PrEP. The Black college women indicated that our educational intervention was extremely helpful (67%) for understanding and learning about PrEP. Post participating in our PrEP education module, regardless of delivery modality, participants reported being likely (62.55–70%) to initiate PrEP in the future. Conclusions Results indicate that Black college women would strongly consider PrEP when provided with basic knowledge, regardless of delivery modality. Participants also showed greater appreciation for in-person delivery and found it to be significantly more helpful and of greater quality for learning about PrEP; comprehension or perceived usefulness of PrEP-related content was relatively the same between groups. PrEP content delivery -- via in-person or online methods – is contingent on learning style and presentation. Trial registration This study has been registered under the ISRCTN Registry as of July 6, 2020. The trial registration number is ISRCTN14792715. This study was retrospectively registered.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA.
| | - Shawnika Hull
- George Washington University, Prevention and Community Health, 1918 F Street NW, Washington, D.C, 20052, USA
| | - Henry Ross
- University of Rochester, Center for Community Practice, 601 Elmwood Ave, Rochester, NY, 14627, USA
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Nikita Dera
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - Natalie Hernandez
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Busza J, Chiyaka T, Musemburi S, Fearon E, Davey C, Chabata S, Mushati P, Dirawo J, Napierala S, Phillips AN, Cowan FM, Hargreaves JR. Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial. Health Policy Plan 2020; 34:337-345. [PMID: 31157368 DOI: 10.1093/heapol/czz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Elizabeth Fearon
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Calum Davey
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sungai Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sue Napierala
- RTI International, 351 California Street, Suite 500, San Francisco, CA, USA
| | - Andrew N Phillips
- Institute for Global Health, UCL, Royal Free Hospital, Rowland Hill Street, London, UK and
| | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - James R Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Wasantioopapokakorn M, Manopaiboon C, Phoorisri T, Sukkul A, Lertpiriyasuwat C, Ongwandee S, Langkafah F, Kritsanavarin U, Visavakum P, Jetsawang B, Nookhai S, Kitwattanachai P, Weerawattanayotin W, Losirikul M, Yenyarsun N, Jongchotchatchawal N, Martin M. Implementation and assessment of a model to increase HIV testing among men who have sex with men and transgender women in Thailand, 2011-2016. AIDS Care 2018; 30:1239-1245. [PMID: 29950108 PMCID: PMC6380890 DOI: 10.1080/09540121.2018.1492697] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
HIV testing among men who have sex with men (MSM) and transgender (TG) women remains low in Thailand. The HIV prevention program (PREV) to increase HIV testing and link those who tested HIV-positive to care provided trainings to peer educators to conduct target mapping, identify high risk MSM and TG women through outreach education and offer them rapid HIV testing. Trained hospital staff provided HIV testing and counseling with same-day results at hospitals and mobile clinics and referred HIV-positive participants for care and treatment. We used a standardized HIV pre-test counseling form to collect participant characteristics and analyzed HIV test results using Poisson regression and Wilcoxon rank sum trend tests to determine trends over time. We calculated HIV incidence using data from participants who initially tested HIV-negative and tested at least one more time during the program. Confidence intervals for HIV incidence rates were calculated using the Exact Poisson method. From September 2011 through August 2016, 5,629 participants had an HIV test; their median age was 24 years, 1,923 (34%) tested at mobile clinics, 5,609 (99.6%) received their test result, and 1,193 (21%) tested HIV positive. The number of people testing increased from 458 in 2012 to 1,832 in 2016 (p < 0.001). Participants testing at mobile clinics were younger (p < 0.001) and more likely to be testing for the first time (p < 0.001) than those tested at hospitals. Of 1,193 HIV-positive participants, 756 (63%) had CD4 testing. Among 925 participants who returned for HIV testing, HIV incidence was 6.2 per 100 person-years. Incidence was highest among people 20-24 years old (10.9 per 100 person-years). HIV testing among MSM and TG women increased during the PREV program. HIV incidence remains alarmingly high especially among young participants. There is an urgent need to expand HIV prevention services to MSM and TG women in Thailand.
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Affiliation(s)
| | - Chomnad Manopaiboon
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | | | - Akechittra Sukkul
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | | | - Sumet Ongwandee
- Ministry of Public Health, Bureau of AIDS, TB and STIs, Nonthaburi, Thailand
| | - Farida Langkafah
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | - Usanee Kritsanavarin
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | - Prin Visavakum
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | - Somboon Nookhai
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | | | | | - Mana Losirikul
- Ministry of Public Health, Khon Kaen Provincial Health Office, Khon Kaen, Thailand
| | - Naruemon Yenyarsun
- Ministry of Public Health, Bureau of AIDS, TB and STIs, Nonthaburi, Thailand
| | - Nuchapong Jongchotchatchawal
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
| | - Michael Martin
- Division of Global HIV & Tuberculosis (DGHT), Thailand Ministry of Public Health-U.S. CDC Collaboration (TUC), Nonthaburi, Thailand
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, USA
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Bekker LG, Roux S, Sebastien E, Yola N, Amico KR, Hughes JP, Marzinke MA, Hendrix CW, Anderson PL, Elharrar V, Stirratt M, Rooney JF, Piwowar-Manning E, Eshleman SH, McKinstry L, Li M, Dye BJ, Grant RM. Daily and non-daily pre-exposure prophylaxis in African women (HPTN 067/ADAPT Cape Town Trial): a randomised, open-label, phase 2 trial. Lancet HIV 2018; 5:e68-e78. [PMID: 28986029 PMCID: PMC6107917 DOI: 10.1016/s2352-3018(17)30156-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The relative feasibility and acceptability of daily versus non-daily dosing of oral HIV pre-exposure prophylaxis (PrEP) among women are unknown. We aimed to investigate the feasibility of non-daily PrEP regimens in adult women. METHODS We did a randomised, open-label, phase 2 clinical trial (HPTN 067/ADAPT) of oral PrEP with emtricitabine plus tenofovir disoproxil fumarate at a research centre in Cape Town, South Africa. Participants were adult women (age ≥18 years) who received directly observed dosing once a week for 5 weeks followed by random assignment (1:1:1) at week 6 to one of three unblinded PrEP regimens for self-administered dosing over 24 weeks: daily; time-driven (twice a week plus a post-sex dose); or event-driven (one tablet both before and after sex). Primary outcomes were PrEP coverage (at least one dose within the 4 days before sex and one dose within 24 h after sex), pills needed or used to achieve regimen-specific adherence and coverage, and symptoms and side-effects. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01327651; the trial is completed and this report presents the final analysis. FINDINGS Between Sept 12, 2011, and Oct 3, 2012, 191 women were enrolled to the trial. 178 (93%) completed directly observed dosing and were randomly assigned one of the three PrEP regimens for the self-administered phase: 59 were allocated the daily regimen, 59 the time-driven regimen, and 60 the event-driven regimen. Median age of women was 26 years (IQR 21-37; range 18-52). In women allocated the daily regimen, 1459 (75%) of 1952 sex events were covered by PrEP, compared with 599 (56%) of 1074 sex events among those assigned the time-driven regimen (odds ratio [OR] 2·35, 95% CI 1·43-3·83; p=0·0007) and 798 (52%) of 1542 sex events among those allotted the event-driven regimen (2·76, 1·68-4·53; p<0·0001). Fewer pills were needed for complete adherence in women allocated non-daily regimens (vs daily regimen, relative mean 2·53 [95% CI 2·39-2·69] for the time-driven regimen and 4·16 [3·59-4·82] for the event-driven regimen; p<0·0001). Side-effects were uncommon. Eight HIV seroconversions occurred overall, with four documented during the self-administered phase (two with the time-driven regimen and two with the event-driven regimen). Adherence to the assigned regimen was 75% (7283 of 9652 doses taken) for women allocated the daily regimen compared with 65% for those assigned the time-driven regimen (2367 of 3616 doses taken; p=0·0028) and 53% for those allotted the event-driven regimen (1161 of 2203 doses taken; p<0·0001). When sex was reported in the previous week, PrEP drugs were detected (above the lower limits of quantification) more frequently in women assigned the daily regimen (73 [68%] of 107 samples) than in those allocated the time-driven regimen (42 [58%] of 72 samples) and the event-driven regimen (41 [41%] of 99 samples). INTERPRETATION Daily PrEP dosing resulted in higher coverage of sex events, increased adherence to the regimen, and augmented drug concentrations than did either time-driven or event-driven dosing. These findings support recommendations for daily use of PrEP with oral emtricitabine plus tenofovir disoproxil fumarate in women. FUNDING HIV Prevention Trials Network.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
| | - Surita Roux
- Synexus Clinical Research SA, Somerset West, Cape Town, South Africa
| | - Elaine Sebastien
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ntando Yola
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - K Rivet Amico
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark A Marzinke
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Vanessa Elharrar
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Michael Stirratt
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | | | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Robert M Grant
- Gladstone Institutes, University of California, and San Francisco AIDS Foundation, San Francisco, CA, USA
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Nideröst S, Gredig D, Hassler B, Uggowitzer F, Weber P. The intention to use HIV-pre-exposure prophylaxis (PrEP) among men who have sex with men in Switzerland: testing an extended explanatory model drawing on the unified theory of acceptance and use of technology (UTAUT). JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2017; 26:247-259. [PMID: 29780687 PMCID: PMC5948261 DOI: 10.1007/s10389-017-0869-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/05/2017] [Indexed: 11/29/2022]
Abstract
Aim The aim of this study was to determine the intention to use pre-exposure prophylaxis (PrEP) when available and to identify predictors of the intention to use PrEP among men who have sex with men (MSM) living in Switzerland. The theoretical model drew on the Unified Theory of Acceptance and Use of Technology and considered additional variables related specifically to PrEP, HIV protection and the resources of MSM. Subject and methods For data collection, we used an anonymous, standardized self-administered online questionnaire. In 2015, we gathered a convenience sample of 556 HIV-negative MSM living in Switzerland. We analyzed the data using descriptive and bivariate statistics and used structural equation modeling to test the hypothesized model. Results Predictors of respondents’ moderate intention to use PrEP were performance expectancy, effort expectancy, perceived social influence, concerns about using PrEP, attitudes toward condom use, negative experiences of condom use and age. These variables were predicted by HIV protection-related aspects and resources. Conclusion The findings provide insights into the complex dynamic underlying the intention to use PrEP.
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Affiliation(s)
- Sibylle Nideröst
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Daniel Gredig
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Benedikt Hassler
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Franziska Uggowitzer
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Patrick Weber
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
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10
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Beyrer C, Das P, Horton R, Ryan O, Bekker LG. The International AIDS Society-Lancet Commission on the future of the HIV response and global health. Lancet 2017; 390:344-345. [PMID: 28745592 PMCID: PMC6754741 DOI: 10.1016/s0140-6736(17)31874-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; the IAS, Geneva, Switzerland.
| | | | | | | | - Linda-Gail Bekker
- the IAS, Geneva, Switzerland; Desmond Tutu HIV Research Foundation, University of Cape Town, Cape Town, South Africa
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11
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Abstract
On May 14, 2014 the Centers for Disease Control and Prevention (CDC) endorsed the drug Truvada as an HIV preventative, called pre-exposure prophylaxis (PrEP). PrEP has been shown to dramatically reduce the risk of HIV infection, but its rate of adoption has been slow, and discourse surrounding it has been marked by stigma and uncertainty. The purpose of this study was to investigate how PrEP was discussed on Twitter. Our analysis focused on barriers to PrEP adoption and stigmatization of PrEP users. We analyzed a random sample of 1,093 top tweets about PrEP posted to Twitter a year before and a year after the CDC's endorsement. Our results showed that tweets likely reinforced uncertainty about barriers to PrEP adoption and that users employed Twitter's functionality to counter stigmatizing narratives about PrEP. We suggest that our findings illuminate both the limitations and strengths of Twitter as a mechanism for health promotion.
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Affiliation(s)
- Joseph Schwartz
- a Department of Communication Studies , Northeastern University
| | - Josh Grimm
- b Manship School of Mass Communication , Louisiana State University
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12
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DiStefano AS, Takeda M. HIV Pre-Exposure Prophylaxis and Postexposure Prophylaxis in Japan: Context of Use and Directions for Future Research and Action. AIDS Patient Care STDS 2017; 31:60-77. [PMID: 28170304 DOI: 10.1089/apc.2016.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Biomedical HIV prevention strategies are playing an increasingly prominent role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. We conducted an ethnographic study to determine the context of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) use and to identify directions for future research and action in Japan. We used data from observational fieldwork in the Kansai region and Tokyo Metropolitan Area (n = 178 persons observed), qualitative interviews (n = 32), documents and web-based data sources (n = 321), and email correspondences (n = 9) in the period 2013-2016. Drug approvals by Japan's regulatory agencies, insurance coverage for medications, and policies by healthcare institutions and government agencies were the main factors affecting PrEP and PEP legality, use, and awareness. Awareness and the observable presence of PrEP and PEP were very limited, particularly at the community level. PrEP and PEP held appeal for Japanese scientists and activists, and for study participants who represented various other stakeholder groups; however, significant concerns prevented open endorsements. Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider formal approval of antiretroviral (ARV) medications for use in PrEP and both occupational and nonoccupational PEP. Once approved, social marketing campaigns can be used to advertise widely and increase awareness. Future research would benefit from theoretical grounding in a diffusion of innovations framework. These findings can inform current and future ARV-based prevention strategies at a critical time in the international conversation.
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Affiliation(s)
- Anthony S. DiStefano
- Department of Health Science, California State University, Fullerton, Fullerton, California
| | - Makiko Takeda
- Program in Comparative Cultures, Graduate School of Humanities, Josai International University, Togane, Japan
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13
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Raifman JRG, Flynn C, German D. Healthcare Provider Contact and Pre-exposure Prophylaxis in Baltimore Men Who Have Sex With Men. Am J Prev Med 2017; 52:55-63. [PMID: 27662698 PMCID: PMC5833975 DOI: 10.1016/j.amepre.2016.07.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/22/2016] [Accepted: 07/11/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) safely and effectively prevents HIV in populations at high risk, including men who have sex with men (MSM). PrEP scale-up depends upon primary care providers and community-based organizations (CBOs) sharing PrEP information. This study aimed to determine whether healthcare provider or CBO contact was associated with PrEP awareness among Baltimore MSM. METHODS This study used 2014 Baltimore MSM National HIV Behavioral Surveillance data, which included data on health care, HIV and sexually transmitted infection testing, and receipt of condoms from CBOs. In 2015, associations were estimated between healthcare contacts and PrEP awareness through logistic regression models controlling for age, race, and education and clustering by venue. Comparative analyses were conducted with HIV testing as outcome. RESULTS There were 401 HIV-negative participants, of whom 168 (42%) were aware of PrEP. Visiting a healthcare provider in the past 12 months, receiving an HIV test from a provider, and having a sexually transmitted infection test in the past 12 months were not significantly associated with PrEP awareness. PrEP awareness was associated with being out to a healthcare provider (OR=2.97, 95% CI=1.78, 4.96, p<0.001); being tested for HIV (OR=1.50, 95% CI=1.06, 2.13, p=0.023); and receiving condoms from an HIV/AIDS CBO (OR=2.59, 95% CI=1.43, 4.64, p=0.001). By contrast, HIV testing was significantly associated with most forms of healthcare contact. CONCLUSIONS PrEP awareness is not associated with most forms of healthcare contact, highlighting the need for guidelines and trainings to support provider discussion of PrEP with MSM.
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Affiliation(s)
- Julia R G Raifman
- Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Colin Flynn
- Center for HIV Surveillance, Epidemiology, and Evaluation, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Danielle German
- Department of Health Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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14
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Harries AD, Suthar AB, Takarinda KC, Tweya H, Kyaw NTT, Tayler-Smith K, Zachariah R. Ending the HIV/AIDS epidemic in low- and middle-income countries by 2030: is it possible? F1000Res 2016; 5:2328. [PMID: 27703672 PMCID: PMC5031124 DOI: 10.12688/f1000research.9247.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 01/10/2023] Open
Abstract
The international community has committed to ending the epidemics of HIV/AIDS, tuberculosis, malaria, and neglected tropical infections by 2030, and this bold stance deserves universal support. In this paper, we discuss whether this ambitious goal is achievable for HIV/AIDS and what is needed to further accelerate progress. The joint United Nations Program on HIV/AIDS (UNAIDS) 90-90-90 targets and the related strategy are built upon currently available health technologies that can diagnose HIV infection and suppress viral replication in all people with HIV. Nonetheless, there is much work to be done in ensuring equitable access to these HIV services for key populations and those who remain outside the rims of the traditional health services. Identifying a cure and a preventive vaccine would further help accelerate progress in ending the epidemic. Other disease control programmes could learn from the response to the HIV/AIDS epidemic.
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Affiliation(s)
- Anthony D Harries
- International Union against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Amitabh B Suthar
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
| | - Kudakwashe C Takarinda
- International Union against Tuberculosis and Lung Disease, Paris, France; AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Hannock Tweya
- International Union against Tuberculosis and Lung Disease, Paris, France; The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nang Thu Thu Kyaw
- International Union against Tuberculosis and Lung Disease, Paris, France; International Union Against Tuberculosis and Lung Disease, Myanmar Country Office, Mandalay, Myanmar
| | - Katie Tayler-Smith
- Médecins sans Frontières, Operational Research Unit (LuxOR), Operational Centre Brussels, Luxembourg, Luxembourg
| | - Rony Zachariah
- Médecins sans Frontières, Operational Research Unit (LuxOR), Operational Centre Brussels, Luxembourg, Luxembourg
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15
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Frankis J, Young I, Flowers P, McDaid L. Who Will Use Pre-Exposure Prophylaxis (PrEP) and Why?: Understanding PrEP Awareness and Acceptability amongst Men Who Have Sex with Men in the UK--A Mixed Methods Study. PLoS One 2016; 11:e0151385. [PMID: 27093430 PMCID: PMC4836740 DOI: 10.1371/journal.pone.0151385] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/27/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent clinical trials suggest that pre-exposure prophylaxis (PrEP) may reduce HIV transmission by up to 86% for men who have sex with men (MSM), whilst relatively high levels of PrEP acceptability have been reported to date. This study examines PrEP awareness amongst sub-groups of MSM communities and acceptability amongst MSM in a low prevalence region (Scotland, UK), using a mixed methods design. METHODS Quantitative surveys of n = 690 MSM recruited online via social and sociosexual media were analysed using descriptive statistics and multivariate logistic regression. In addition, n = 10 in-depth qualitative interviews with MSM were analysed thematically. RESULTS Under one third (29.7%) of MSM had heard of PrEP, with awareness related to living in large cities, degree level education, commercial gay scene use and reporting an HIV test in the last year. Just under half of participants (47.8%) were likely to use PrEP if it were available but there was no relationship between PrEP acceptability and previous PrEP awareness. Younger men (18-25 years) and those who report higher risk UAI were significantly more likely to say they would use PrEP. Qualitative data described specific PrEP scenarios, illustrating how risk, patterns of sexual practice and social relationships could affect motivation for and nature of PrEP use. CONCLUSION These findings suggest substantial interest PrEP amongst MSM reporting HIV risk behaviours in Scotland. Given the Proud results, there is a strong case to investigate PrEP implementation within the UK. However, it appears that disparities in awareness have already emerged along traditional indicators of inequality. Our research identifies the need for comprehensive support when PrEP is introduced, including a key online component, to ensure equity of awareness across diverse MSM communities (e.g. by geography, education, gay scene use and HIV proximity), as well as to responding to the diverse informational and sexual health needs of all MSM communities.
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Affiliation(s)
- Jamie Frankis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Ingrid Young
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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16
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Abstract
INTRODUCTION Female sex workers (FSWs) in sub-Saharan Africa are at a particularly high risk for HIV infection. Postexposure prophylaxis (PEP) is available as part of an HIV care and prevention program through dedicated FSW clinics in Nairobi, Kenya, but is underutilized. We evaluated PEP knowledge, access, and adherence among clinic attendees. METHODS An anonymous questionnaire was administered to unselected HIV-uninfected FSWs. Participants were dichotomized into high and low HIV risk categories based on self-reported sexual practices. Prior PEP use, knowledge, and adherence were then evaluated. RESULTS One hundred and thirty-four HIV-uninfected FSWs participated, with 64 (48%) categorized as being at high risk for HIV acquisition. High-risk FSWs were less likely to have heard of or accessed PEP than lower risk FSWs (37.5 vs. 58.6%, P = 0.014; and 21.9 vs. 40.6%, P = 0.019, respectively). Among higher risk FSWs, those who had accessed PEP were more likely to report treatment for a genital infection (71.4 vs. 42.0%, P = 0.049) or sex with an HIV-infected man (62.5 vs. 37.5%, P = 0.042) during the last 6 months. However, only 35.7% of high-risk women accessing PEP completed a full course of treatment, and noncompleters were more likely to report prior unprotected sex with an HIV-infected man (P = 0.023). CONCLUSION Despite freely available PEP for Nairobi-based FSWs, women at highest risk were less likely to have heard of PEP, access PEP, or complete the full course of therapy once initiated. Program delivery needs to be improved to ensure that FSW most at risk are able to benefit from this resource.
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17
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Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study. Lancet HIV 2015; 2:e393-400. [PMID: 26423553 DOI: 10.1016/s2352-3018(15)00127-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Widespread HIV screening and access to highly active antiretroviral treatment (ART) were cost effective in mathematical models, but population-level implementation has led to questions about cost, value, and feasibility. In 1996, British Columbia, Canada, introduced universal coverage of drug and other health-care costs for people with HIV/AIDS and and began extensive scale-up in access to ART. We aimed to assess the cost-effectiveness of ART scale-up in British Columbia compared with hypothetical scenarios of constrained treatment access. METHODS Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1997 to 2010. We estimated HIV incidence, prevalence, mortality, costs (in 2010 CAN$), and quality-adjusted life-years (QALYs) for the study period, which was 1997-2010. We calculated incremental cost-effectiveness ratios from societal and third-party-payer perspectives to compare actual practice (true numbers of individuals accessing ART) to scenarios of constrained expansion (75% and 50% probability of accessing ART). We also investigated structural and parameter uncertainty. FINDINGS Actual practice resulted in 263 averted incident cases compared with 75% of observed access and 676 averted cases compared with 50% of observed access to ART. From a third-party-payer perspective, actual practice resulted in incremental cost-effectiveness ratios of $23 679 per QALY versus 75% access and $24 250 per QALY versus 50% access. From a societal perspective, actual practice was cost saving within the study period. When the model was extended to 2035, current observed access resulted in cumulative savings of $25·1 million compared with the 75% access scenario and $65·5 million compared with the 50% access scenario. INTERPRETATION ART scale-up in British Columbia has decreased HIV-related morbidity, mortality, and transmission. Resulting incremental cost-effectiveness ratios for actual practice, derived within a limited timeframe, were within established cost-effectiveness thresholds and were cost saving from a societal perspective. FUNDING BC Ministry of Health, National Institute of Drug Abuse at the US National Institutes of Health.
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